Present status, trends and needs in fast neutron therapy.

Fast neutrons were introduced in cancer therapy, in the 1970s, on the basis of radiobiological arguments. After 30 years, these arguments are still valid and have not been refuted by more recent experimental data. Although neutron therapy has been applied routinely for about 25 years, there is still no general agreement concerning its value and its place among the other radiation therapy techniques. In order to be able to draw objective conclusions from the available clinical results and mainly to compare the results from the different centres in a relevant way, a consensus has to be reached on several issues: 1) a protocol for dose measurement in a homogeneous phantom in reference conditions; 2) dose computation at the level of the target volume(s) and the normal tissues at risk; 3) method of dose specification for reporting; and 4) specification of radiation quality in neutron therapy and the related RBE problems. The International Commission on Radiation Units and Measurements (ICRU) has published recommendations on Clinical Neutron Dosimetry (ICRU Report 45, 1989) which are now universally applied. As far as dose specification for reporting is concerned, ICRU recommendations for photons (ICRU Report 50, 1993) can be extended and adapted for fast neutrons. However, special care is required to take into account the tissue compositions. In fast neutron therapy, specification of radiation quality raises a particular problem because the neutron RBE, relative to gamma rays, is higher than unity (it ranges from about 2 to 5) and furthermore significantly varies with neutron beam energy. In addition, the RBE also varies with dose and biological system. In these conditions, besides the classical concept of RBE introduced jointly by the ICRP and the ICRU in 1963, the concepts of "reference RBE" and "clinical RBE" are proposed here for application in fast neutron therapy. Microdosimetry provides an adequate method to describe radiation quality, at the point of interest in the irradiated medium and in the actual irradiation conditions. From the analysis of microdosimetric spectra, a RBE value of a particular neutron beam, for a given biological system, can be predicted provided that the biological weighing function for that biological system has been obtained. In any case, correlation of the microdosimetric description of a given beam and the experimental RBE values for that beam improves the confidence in both sets of data.